“Everything old is new again”, so the saying goes. As a person who has implemented a number of changes in the health care industry around the region, it is no surprise that I enjoy the challenge of change. I like engaging with new concepts and collaborating to roll-out new systems.
And if you look back in time, things have always been in a state of change. We look toward organisations such as Uber and AirBnB, raise our eyebrows and exclaim “They have been disruptive to their industry” as if industry disruption is something new. Industry disruption is not new. It has been happening throughout history. More recently we call it “disruption”. We used to call it “a significant change.” Just ask the horse and carriage transport industry, feudal farming, pre-penicillin medicine or the traditional postal system.
Back to now and a recent article from Boston announced the local trial of “UberEMS” (Emergency Medical Services). This trial gave the public the ability to call an Uber ambulance vehicle much like you call for a normal UberX or UberBlack car. Have chest pain? Call UberALS. Something minor? Call UberBLS. You get the idea.
The article was shared across social media, discussed with fevered concern on podcasts, and caused quite a few excited industry discussions about whether this new Uber model was going to be a radical disruptor to the pre-hospital ambulance industry.
What is does, however, is raise the issue of privatised ambulance services in places where the private sector does not typically provide pre-hospital care. In Australia, emergency ambulance services are basically the exclusive domain of government funded providers, whether it be under a statutory authority or part of a health department.
Over the last 10 years, the private sector has had increasing access to non-emergency patient transports. The non-emergency sector is ideal for private sector participation as they;
work under different legislative framework to emergency response providers,
revolve around people who need some form of transport to attend medical appointments plus
require non-emergency booked ambulance transportation (as opposed to a taxi transport).
It can be profitable as well - as demonstrated by the number of companies offering this service in Victoria. New South Wales has relatively recently allowed private providers into the state, although the NSW Health Department have been running their own inter-hospital, non-“ambulance”, non-emergency transport service for many years. In an environment where both sides of politics seem to outsource non-core functions from government operations, I wonder why more booked, routine (non-emergency) ambulance transports are not outsourced to the private sector. This would allow emergency providers to concentrate on their core business. Indeed, I am surprised governments have not seized the opportunity to privatise this part of the service.
The proposed (albeit satirical) UberAmbulance operational model is an unlikely and unworkable addition in the emergency space. While Uber, and many other private providers, look toward health to strengthen their organisational and financial strategy, any model based purely on ad-hoc ambulance transport requests would be ineffective for a number of reasons.
What the much-hyped Uber disruption brings is a need to re-look at our existing systems, remain vigilant for fresh approaches to how services can be provided, be open to change and competition, and allow space to consider exciting opportunities.
Craig Hooper has more than 25 years experience in health and emergency ambulance operational management, emergency planning, health service delivery and service redevelopment. Craig is a member of the Australasian College of Health Service Management and Australia Malaysia Business Council. His book “Time to Respond- Pre-hospital leadership and operational management” comes out in February 2015.
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